Declaration

BY CLICKING ACCEPT AND SUBMIT, I HEREBY:

Declare and
affirm that the statements
made herein are true, correct and complete. You may contact any person or company
that I have listed and I fully release all parties from any and all liability for
any damage it may result.

Understand
and agree that a consumer
report may be obtained in connection with my application.

Understand
that Merchants Preferred Lease-Purchase Services will only charge an application
fee/ initial payment (based on state requirement) to the card provided if a contract
is prepared and generated.

Understand
that this application
is subject to approval by Merchants Preferred Lease-Purchase Services at its offices
in the State of Georgia and that all payments are remitted to Georgia.

Understand
this action counts as
my electronic signature.

If any information has changed, current information must be updated. All information
will be validated. Does any information need to be updated?